Bolster, Lillian NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District
(Town, Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Registered No.
Dist. No.
5601 County Warren Town, Village
or City City of Glens Falls
If city, give street address)
Name of deceased Lillian L. Bolster Veteran No
(If veteran, give name of War)
Female Single, married,widowed, Vr1.dOwed Sept. 1
Sex or divorced (write the word) Date of Death P 19 79
Age 79 Years Months Days Birthplace New York State
Cause of Death Carcinoma of rectum
Certificate was signed by Harry M. DeParl,Jr. M.D.
Address 407 Glen St. , Glens Falls, N.-x.
Place of Burial (or Removal) Town of Queensbury, N,Y,
(I body isto be temporarily WestelGlll in enspaFalls CemeterySe t
Cemetery jj Date of Burial P • 4 19--79-
(If body is to be temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same
for registration, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HERE-
BY GRANT A PERMIT
to Regan & Denny,Inc. Quaker Rd., Glens Falls,. N.Y.
(Name) (Address)
the Undertaker to hold temporarily and Inter the body
(Unlertak r or person having charge of corpse) , r ve, or o rwise dispose of (state how))
Dated Sept. 4 1979__ (Signed)
This Permit is sufficient for the Removal (and Interment or Crematio of a body to any rt o e State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
FORM VS.61.(REV.6/63)(7A2-53)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of ti 4J4-c 44 was GZ l V" 1971
(Interment orzerematian) �f
(Name of Cemetery.
Section Lot No. Grave No.
(Signed) ►J%`
(Person in Charge)
A
Address LOCI
Person in charge must return this Permit to the Registrar
of his District within SEVEN (7) DAYS from above daiel: .,)
If no person is in charge, the FUNERAL DIRECTOR S
UNDERTAKER MUST SIGN ABOVE STATEMEN
write across the face of the Permit the words "No person •
charge," and FILE PERMIT WITHIN THREE (3) DAYS
with the Registrar of District in which cemetery is located.
1
SEXTONS, FUNERAL DIRECTORS and UNDER-
TAKERS violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOL-
LARS NOR MORE THAN FIFTY DOLLARS FOR THE
FIRST OFFENSE. The law will be enforced. Local Regis-
trars are required, under penalty, to report violations thereof.